Division of Intramural Population Health Research (L.A.S., S.L.M., K.K., K.C.S., N.J.P., J.W., E.F.S.) and Program of Reproductive and Adult Endocrinology (K.K.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892; Division of Reproductive Endocrinology and Infertility (A.O.H.), Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah 84132; and Department of Social and Preventive Medicine (J.W.-W.), School of Public Health and Health Professions, University at Buffalo, Buffalo, New York 14214.

Abstract

CONTEXT:

Hyperandrogenism is a hallmark of polycystic ovary syndrome (PCOS) in women with irregular menses, yet the relationship between androgens and ovarian dysfunction remains poorly understood in eumenorrheic women.

OBJECTIVE:

The objective of the study was to evaluate whether sporadic anovulation was associated with higher T and anti-müllerian hormone (AMH; marker of ovarian follicle count) concentrations in eumenorrheic women.

DESIGN:

This was a prospective cohort study from 2005 to 2007.

SETTING:

The study was conducted at the University of Buffalo in western New York state.

PARTICIPANTS:

A total of 259 eumenorrheic women without a self-reported history of infertility, PCOS, or other endocrine disorder participated in the study.

MAIN OUTCOME MEASURES:

Total T and AMH were measured five to eight times per cycle for one (n = 9) or two (n = 250) cycles per woman (n = 509 cycles) with timing of menstrual cycle phase assisted by fertility monitors. Anovulatory cycles were defined biochemically by progesterone and LH concentrations. Repeated-measures ANOVA was conducted on log-transformed data with adjustment for age.

CONCLUSIONS:

Mechanisms of androgen-related ovulatory dysfunction that characterize PCOS in women with menstrual disturbances may occur across a continuum of T concentrations, including in eumenorrheic women without clinical hyperandrogenism.

Total and free T across the menstrual cycle by ovulatory status. Ovulatory cycles are depicted by solid circles and anovulatory cycles by open circles. Data are geometric means ± 95% CIs. *, Different (P < .05) between anovulatory and ovulatory cycles at a given cycle phase.

The LH to FSH ratio and AMH by quartile (highest 25th percentile of women vs lowest 25th percentile) of total T at menses concentration: lowest quartile is represented by diamonds and the highest quartile by stars. Data are geometric means ± 95% CIs. *, Different (P < .05) between the first and fourth quartiles at a given cycle phase.